Mortgage_Davis (2)r"'no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
. • FOR DEDUCTION FROM ASSESSED VALUATION
� State Fotm 43709 (R71 / 609)
�' - Pr¢svibed by �epartmerd ol Local Govemment Friance
INSTRUCTIONS:
To be filed in person w by mad vnN the CountyAuditof or Counry Recorder o/ the county where the property is located.
Filing Dates: 1) Real Proparty: Must file dunng the year /or which Na deduction is sought.
2) Mo6�7e / Manufactured Homes rrot essesced as Real Properly Musf fife dunng fhe fwelve (12) months
before March 37 of each year Ne deduction rs sought.
See reverse side (w additional instrucGOns and nualifications. f
Pssessed rahc d ra�l pmPem/ as ot
Marth 1. amnt Year
R no.
11'd1IC C!1
Name of (rongagee « mntrad uuer
= �1�=�6 - �roo -oo� .o4?-Gb S� I __ � =
��a9e41�7LWa�/ e6tedrress unPaid as o( �Mort�ag PPG�� indebtedness unPaid as N
Address W rtart9a9ce or cantracl se4er (nvnber end
Name of a55ignee
6elov.!
� �:
stafi. a�
mde)
AOdress o1 assignee (��rt�� ��C �Y. �a. and LP oode)
Does applia /� �/'�"�
counry m Ind � O(O 4-/ . . . . . . . .
]�1'9\\'C1-'\0........ .
' ............. :OU
935
���,�. � 5���0.°7 ....... —
za— l�N � � � : �a zo
_ ,-
Sig�awre M CamN Auditor
VYhatTa�dtg Districl?
zo
SpouSe,
Year
f,oun�NLpitor
Counry Recorder
Yes L� No
IS Mf pfOpCflY T VUCSDOfI: Mfllld%/L4GSSM
❑ Real RoPenY ❑ %�^�Y�
Has Nis tleduCia� Deen requestetl on property
tor cu�t yeaR �.. r� .
� zo_
� �,�,�. �y ,��
I/ We certify under ihe penalry oi peryury that the above arW foregoing informalion is W e and cortect aM that the applicant is a resident of Indiana aM
owner I conVaa buyer of the afaementioneC property on date application is filed.
Penon
Power dMart�ey ar Cy IC G1.142-0]
AdCr� of aW�aaed person (numbe� ami sUee; dty, sle(e. and LP cotle)
Date (month. tlay,
�
�